Chapter 41 Lower GI Meds

What is the correct rationale for why the nurse would administer a laxative at a separate time from the client's other medications?

Laxatives may reduce absorption of other drugs present in the GI tract.

A nurse is aware that diphenoxylate HCl with atropine sulfate is an effective adjunct in the treatment of diarrhea. For which clients could the administration of this drug be potentially harmful?

An 80-year-old man who has diarrhea secondary to Clostridium difficile infection

What is the priority nursing diagnosis for an 89-year-old client with frequent liquid stools?

Deficient fluid volume

The nurse should educate the client prescribed a stimulant cathartic to be alert for which common adverse effect?

Diarrhea

A client who has suffered a myocardial infarction is prescribed a laxative to help prevent straining during defecation. Which medication would the nurse expect to administer?

docusate

While discussing the use of laxatives a student asks the nursing instructor what indicates normal bowel elimination. What would be the best response by the instructor?

"A soft, formed stool."

During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea?

"Can you tell me what you ate the last 24 hours?"

A nurse is teaching a client about diarrhea. Which statement by the client regarding diarrhea would indicate a need for additional teaching?

"Diarrhea is a disease that has no cure."

The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructions regarding these medications when which statement is made?

"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."

The nurse is teaching the client how to treat diarrhea and discussing general guidelines. The nurse reminds the client to stop taking the antidiarrheal medication and to call the clinic if fever and abdominal pain become severe, after how many days?

2

The nurse should counsel a client to discontinue use of over-the-counter antidiarrheals and seek treatment from a health care provider if diarrhea persists for how long?

2 days

A nurse instructs a client taking an antidiarrheal agent to stop the drug and call the health care provider if the client does not experience relief within which time frame?

48 hours

The nurse is seeing a 69-year-old client who is highly physically active and consumes a balanced diet that includes adequate fluid intake. Despite this, the client states experiencing occasional constipation in recent months. What remedy should be the nurse's first suggestion?

A bulk-forming (fiber) laxative

The nurse is teaching a client who is to be discharged with an order to use chemical stimulant laxatives PRN. The nurse should caution the client about what potential adverse effect?

Abdominal cramping

A nurse is caring for a client who has developed diarrhea after antibiotic administration. The client has a BUN of 35 and creatinine of 1.8. The provider has ordered diphenoxylate with atropine for the client. What action should the nurse implement?

Call the prescriber about the laboratory tests.

The nurse administers loperamide to decrease the number and liquidity of stool by what mechanism?

Decreasing intestinal motility

A client reports to the nurse about needing to strain to defecate. The client adds that defecating is very painful. What laxative will the nurse suggest to the prescriber based on the painful defecation?

Docusate

A new mother required an episiotomy during the birth of her baby. Two days after delivery, the client is in need of a laxative. What will be the most effective drug for the nurse to administer?

Docusate

The nurse is caring for a new mother who had to have an episiotomy during the birth of her baby. Two days after delivery the client is in need of a laxative. What will the nurse administer?

Docusate

An older adult client has received a third dose of diphenoxylate. In addition to monitoring the number and consistency of the client's stools, the nurse should prioritize what assessment?

Fluid and electrolyte balance

When reviewing a client's medication history, the nurse notes that the client has recently completed a course of treatment with nitazoxanide. The nurse is justified in suspecting that the client was infected with what microorganism?

Giardia lamblia

A group of students are reviewing the actions of laxatives on the GI tract. The students demonstrate understanding when they state what about bulk stimulants?

Increase the fluid in the intestinal contents

A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone (Mylicon) for her discomfort. Which will the nurse monitor most closely during the client's drug therapy?

Increased abdominal pain and vomiting

In pharmacology class the students are learning about the mechanism of action of different laxatives. What would the students learn about the mechanism of action of psyllium hydrophilic mucilloid?

Increasing mass and water content of stool

The nurse is preparing to administer polycarbophil to a client experiencing liquid stools. How should the nurse describe the action of this substance?

It absorbs large amounts of water and decreases fluidity of stools.

A client is using psyllium hydrophilic mucilloid to promote evacuation of stool. What is the action of this medication?

It increases mass and water content of stool, promoting evacuation.

A client, diagnosed with alcoholism and chronic liver failure, is confused and has an elevated serum ammonia level. What laxative will be administered to lower the serum ammonia level?

Lactulose

Lactulose (Chronulac, Cephulac) is prescribed for a client. The nurse knows that which of these statements regarding lactulose are correct? Select all that apply.

Lactulose should produce two or three soft stools every day. Lactulose is used to manage hepatic encephalopathy. Lactulose can cause electrolyte imbalance.

The nurse is teaching a client about diphenoxylate with atropine sulfate which has been prescribed for treatment of acute diarrhea. For which adverse effect should the nurse teach the client to anticipate?

Nausea

The nurse teaches the client to best promote optimal GI function by including what in the daily routine?

Nutritious diet, adequate fluid intake, and exercise

A client is scheduled for a colonoscopy in the morning. What laxative would the nurse expect to be prescribed the evening before the procedure?

Polyethylene glycol-electrolyte solution

A client is scheduled for a colonoscopy. The nurse knows that the preferred drug for bowel cleansing before this procedure is:

Polyethylene glycol-electrolyte solution (NuLYTELY)

The nurse knows that which of the following are appropriate uses for laxative drugs? Select all that apply.

Preparation for colonoscopy With opioid analgesics Hepatic encephalopathy

A client is advised to use a bulk-forming laxative to alleviate constipation. The nurse will recommend:

Psyllium (Metamucil)

The nurse should know that lactulose achieves a therapeutic effect by which means?

Pulling water into the intestinal lumen by osmotic pressure

Which is an important assessment for the nurse to make before administering a laxative?

Question the client regarding the type and intensity of symptoms to provide a baseline evaluation.

The client has been prescribed diphenoxylate with atropine (Lomotil) for diarrhea. The nurse recognizes that this drug is effective against diarrhea because of which action?

Slows peristalsis by acting on the smooth muscles of the intestine

A client with a history of constipation has been taking over-the-counter laxatives with good success. The client tells the nurse that he or her is relieved to have found a solution to his or her constipation. When providing health education, the nurse should prioritize what topic?

Strategies for preventing dependence on laxatives

How is constipation best defined?

The infrequent and painful expulsion of hard, dry stools

An adult client asks the nurse how many stools per week is considered "normal." The nurse should indicate that there is no fixed number but that functional constipation is diagnosed at what frequency?

Three stools per week

A client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, "I'm just not feeling right." What is the priority question the nurse should ask this client?

Timing of medication administration

A client is taking psyllium hydrophilic mucilloid daily. What information should be included in the discharge plan?

Up to 30 g of fluid with the medication can be divided over several divided doses daily.

A client diagnosed with irritable bowel syndrome has been prescribed alosetron. The nurse should ensure that the client has been made aware of what potentially severe adverse effect?

bowel obstruction

Client teaching frequently includes explaining the potential adverse effects of prescribed medications. What classifications of medication can cause diarrhea? Select all that apply.

antibacterials selective serotonin reuptake inhibitors (SSRIs) magnesium-based antacids antineoplastic agents

A client experiencing diarrhea asks the nurse about over-the-counter (OTC) antidiarrheals. Which OTC should not be taken with aspirin?

bismuth subsalicylate

The parent of an adolescent client reports that the teen has chronic diarrhea and lacks an appetite. Assessment reveals that the client is significantly underweight, has dry hair, and exhibits erosion of tooth enamel. When asked, the client reports occasional laxative use for "constipation." What condition does the nurse consider most likely?

bulimia with laxative abuse

A nurse is teaching a group of older adults about nonpharmacologic strategies for preventing constipation. The nurse should recommend what practices? Select all that apply.

consuming a high-fiber diet engaging in frequent physical exercise drinking 6 to 10 glasses of fluid each day

A client reports the intention to use an over-the-counter bismuth product. The nurse should inform the client that there is a potential that the medication will cause what side effect?

dark stool

A male client develops diarrhea secondary to antibiotic therapy. He is to receive two tablets of diphenoxylate HCl with atropine sulfate (Lomotil) orally as needed for each loose stool. The nurse should inform him that he may experience:

dizziness

The client states that prior to exams at school, the client has abdominal cramping and diarrhea. What does the nurse suspect is the trigger for these signs and symptoms?

functional diarrhea disorder

A nurse is caring for a client prescribed an antidiarrheal drug. Based on the nurse's understanding of the drug, the nurse would administer the drug cautiously to the client with which condition?

hepatic impairment

The nurse is providing care to a client with hepatic encephalopathy. Which would the nurse anticipate administering to assist in lowering the client's blood ammonia level?

lactulose

A 75-year-old client is prescribed magnesium hydroxide for constipation. The nurse's assessment reveals that the client is being treated for rheumatoid arthritis and hypertension. The client is in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the client's:

medication history

A hospital client has been scheduled for a barium enema the following morning. The nurse should anticipate what prescription for the client's bowel preparation?

polyethylene glycol-electrolyte solution

A client asks the nurse about medications he can get without a prescription to help relieve his excess gas. Which would the nurse suggest?

simethicone